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Objective: Thyroid cancer has a disproportionately negative effect on quality of life (QOL) compared to malignancies with a worse prognosis. QOL of patients with indeterminate thyroid nodules has not been previously evaluated. We aimed to assess the impact of molecular test results on QOL of patients with indeterminate thyroid nodules. Methods: A short version of the Thyroid-Related Patient-Reported Outcome (ThyPro-39) assessed QOL of patients who underwent thyroid fine needle aspiration (FNA) biopsy throughout UCLA Health from May 2016 to June 2017. All patients with indeterminate biopsy results underwent molecular testing with either Afirma Gene Expression Classifier (GEC) or ThyroSeq v2 at the time of the initial biopsy. QOL associated with symptoms of goiter, anxiety, depression, and impaired daily life were analyzed. Results: Of 825 consented patients, 366 completed the assessment (44.4% response rate). FNA results included 76% benign, 7% malignant, and 17% indeterminate. There were no differences in QOL between patients with a benign FNA and patients with an indeterminate result with benign molecular testing. In patients with an indeterminate FNA, symptoms of goiter (20.5 vs. 10.4, P = 0.033) and depression (33.3 vs. 21.0, P = 0.026) were worse for patients with suspicious versus benign molecular test results; however, no significant differences were observed in anxiety or impaired daily life. Conclusions: A benign molecular test result may provide reassurance for patients with indeterminate thyroid nodules that the risk of malignancy is low. Long-term follow-up is necessary to determine if benign molecular test results maintain improved QOL.

Introduction Mild parkinsonian signs (MPS) are associated with morbidity. Identification of MPS progression markers may be vital for preventive management, yet has not been pursued. This study aimed to ascertain clinical/neuroimaging features predictive of MPS progression. Methods 205 participants in the Health ABC Study were included. MPS was defined using published guidelines. MPS progression was evaluated by determining UPDRS-III change between baseline and follow-up ≥2 years later. Standard brain MRI and DTI were obtained at baseline. Correlation coefficients between demographics, vascular risk factors, imaging markers, and UPDRS-III change were adjusted for follow-up time. Linear regression was used to adjust for possible confounders in the relationship between imaging markers and MPS progression. Results 30% of participants had baseline MPS. Demographics and risk factors did not differ significantly between participants with MPS (MPS+) and without MPS (MPS-). Mean follow-up time was 3.8±0.8 years. Older age, male gender, diabetes were associated with faster rate of UPDRS-III change in MPS- but not MPS+ participants. Among MPS- participants, the only imaging marker associated with faster UPDRS-III progression was higher gray matter mean diffusivity (MD), widespread in various cortico-subcortical bihemispheric regions, independent of age, gender, diabetes. No imaging features were associated with UPDRS-III change among MPS+ participants. Conclusions Lower gray matter integrity predicted MPS progression in those who did not have baseline MPS. Microstructural imaging may capture early changes related to MPS development, prior to macrostructural change. Any future management promoting gray matter preservation may inhibit MPS development.

Context Understanding clinical characteristics and treatment selection for elderly patients is essential in the era of novel agents. informCLL ( NCT02582879 , September 2015 initiation) is an ongoing, US-based, prospective, real-world observational registry of patients with CLL. Objective To characterize overall demographics of previously untreated elderly CLL patients and compare clinical factors and treatment choice of those aged 65-74 years (Group 1) versus ≥75 years (Group 2). Design/Patients An interim analysis (November 2018 data cut) of previously untreated patients from the informCLL registry who were aged ≥65 years and received single-agent ibrutinib, chemoimmunotherapy, or immunotherapy at enrollment. Association between age groups and treatment choice was assessed by multinomial logistic regression after adjusting for comprehensive demographic and clinical factors. Results Analysis included 449 elderly patients (Group 1: 238; Group 2: 211); median age was 74 years. Most patients were male (64.1%), white (92.4%), treated in community settings (94.9%), and Medicare/Medicaid-insured (88.4%). Median time from initial diagnosis to first treatment was 2.0 years. The majority had an Eastern Cooperative Oncology Group (ECOG) score ≤ 1 (87.1%) and Charlson Comorbidity Index (CCI) score ≤ 1 (62.0%). The most common comorbidities were hypertension (69.3%), other cardiovascular disorders (29.2%), non-CLL malignancies (26.3%), and connective tissue diseases (24.5%). Documented cytogenetic/molecular testing rates were low: TP53, 6.01%; IGHV, 5.35%; CLL FISH, 17.8%; any of the three, 18.7%. 202 (45.0%) patients received ibrutinib, 170 (37.9%) received chemoimmunotherapy, and 77 (17.1%) received immunotherapy. Group 2 (vs Group 1) had poorer performance status (ECOG scores ≥2, 12.9% vs 5.7%, p=0.01), more comorbidities (CCI scores ≥2, 45.5% vs 31.1%, p Conclusions Previously untreated real-world CLL patients aged ≥75 years (vs 65-74 years) had poorer performance status, more comorbidities, lower cytogenetic/molecular testing rates, and a higher likelihood of receiving ibrutinib versus chemoimmunotherapy as initial treatment.

Background Transvenous lead extraction carries a risk of significant complications. Although intraoperative transesophageal echocardiography (TEE) is widely used to monitor cardiac performance and structures, its utility during transvenous lead extraction has not been well described. Objective This study evaluates the utility of TEE during transvenous lead extraction. Methods The records of 108 consecutive patients who underwent transvenous lead extraction with TEE guidance were reviewed. Results Transvenous extraction of 202 leads was attempted; complete extraction was achieved for 174 leads (86%) and partial extraction for 13 leads with clinically acceptable outcomes in 187 leads (93%). Mean age of the patients was 63 ± 21 (14-99) years and 37% were female. The average number of leads per patient was 1.9 (1-6). Mean implant duration was 71 ± 57 (1-360) months. Indications for extraction were pocket infection (53 patients), bacteremia (33), atrial J-lead fracture or recall (13), lead malfunction (8), and venous thrombosis (1). TEE identified critical findings that prompted emergency surgical intervention or converted transvenous lead extraction to surgical explantation in 6 patients (two cases with cardiac laceration, 3 cases of cardiac tamponade, and one case with a large vegetation and a patent foramen ovale). TEE eliminated the need for the premature termination of the procedure in 11 patients by excluding significant structural cardiac damage. Overall, TEE provided clinically useful information during transvenous lead extraction in 17 cases (16%). Conclusions TEE during transvenous lead extraction provides valuable real-time information that improves efficacy and safety.

s / Drug and Alcohol Dependence 140 (2014) e86–e168 e135 Contraception continuation among female exotic dancers seeking mobile reproductive health services concurrent with syringe exchange Caitlin E. Martin1, Mishka Terplan2, J. Han3, P. Chaulk4, C. Serio-Chapman3 1 Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, United States 2 Departments of Obstetrics, Gynecology, and Reproductive Sciences & Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States 3 Community Risk Reduction Services, Baltimore City Health Department, Baltimore, MD, United States 4 Bureau of HIV/STD Services, Baltimore City Health Department, Baltimore, MD, United States Aims: Female exotic dancers are an understudied population with a high prevalence of drug and alcohol use, risk factors for transactional sex and inconsistent condom use. In 2009, the Baltimore City Health Department expanded their mobile syringe exchange program to include reproductive health services in the “Red Light” district. The objective of this study was to describe depot medroxyprogesterone acetate (Depo-Provera) continuation patterns among female exotic dancers seeking these mobile health services. Methods: We performed a retrospective analysis of 75 clients who initiated Depo-Provera at a mobile health clinic attached to a syringe exchange from November 2009 to August 2012. Demographics, Depo-Provera uptake and continuation over 12 months were assessedby chart review. Characteristics between clientswho continued Depo-Provera at 3 months and those who did not were compared using chi-square and t-tests. Results: Seventy-two percent (N=52) of clients were African American, and 62% (N=42) were 24 years or younger. At 3 months, 36% (N=25) continued Depo-Provera. Clients who were Caucasian (p=0.03) and received other reproductive health services (p

Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange sex for money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the “red light district” in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program’s operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely. (Am J Public Health. 2012;102:1833–1836. doi:10.2105/AJPH.2012.300842)

The accuracy and reproducibility of caliper and cinevideodensitometric measurements of coronary stenotic dimensions were compared in radiographic phantom models and in coronary arteriograms of 28 patients undergoing coronary angioplasty. Projected, single-plane coronary cine frames were analyzed by a computer-assisted videodensitometric method, which measures stenotic cross-sectional area without assumptions about lesion geometry. The accuracy (2.4%) and precision (+/- 1.9%) of cinevideodensitometry for measuring percent area stenosis in Plexiglas models of eccentric stenotic lesions was superior to the accuracy (24.7%) and precision (+/- 5.4%) of caliper measurements. Interobserver variability was significantly (p less than 0.05) better for cinevideodensitometric (r = 0.98; SEE = 6.4%) than for caliper measurements (r = 0.87; SEE = 13.1%). After angioplasty, percent diameter stenosis measured by calipers fell from 70 +/- 12% to 30 +/- 15%. Mean percent area reduction measured by cinevideodensitometry fell from 89.1 +/- 8% to 40.1 +/- 22% and stenotic area increased five-fold, from 0.59 +/- 0.5 to 3.47 +/- 1.6 mm2. Pre and post PTCA gradients did not correlate with lesion dimensions. Cinevideodensitometric measurements of absolute stenotic dimensions were more reproducible than relative measurements expressed as a percentage, due to the tapered caliber of normal arterial segments. Thus, cinevideodensitometric measurements were more accurate and reproducible than caliper measurements. The angiographic effects of coronary angioplasty are best measured by cinevideodensitometry, because residual lesions post PTCA are often eccentric, have indistinct margins, and are better characterized by changes in area than by changes in diameter.